Healthcare Provider Details

I. General information

NPI: 1699809343
Provider Name (Legal Business Name): OPTIX OF LONG ISLAND, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 S OYSTER BAY RD
PLAINVIEW NY
11803-3313
US

IV. Provider business mailing address

431 S OYSTER BAY RD
PLAINVIEW NY
11803-3313
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-6330
  • Fax:
Mailing address:
  • Phone: 516-931-6330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT003883
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JOEL N KESTENBAUM
Title or Position: PRES
Credential: OD
Phone: 516-931-6330